Indications: pituitary tumors, diabetic retinopathy, metastatic cancer of the breast or prostate, which may be endocrine dependent

Surgical approaches

Craniotomy: usually transfrontal

Transphenoidal: incision made in inner aspect of upper lip and gingiva; sella turcica is entered through the floor of the nose and sphenoid sinuses

Nursing care

In addition to pre-op care of the craniotomy client, explain post-op expectations.

In addition to post-op care of the craniotomy client, observe for signs of target gland deficiencies (diabetes insipidus, adrenal insufficiency, hypothyroidism) due to total removal of the gland or to post-op edema.

Perform hourly urine outputs and specific gravities; alert physician if urine output is greater than 800-900 ml/2 hours or if specific gravity is less than 1.004.

Administer cortisone replacement as ordered.

If transphenoidal approach used

Elevate the head of the bed to 30° to decrease headache and pressure on the sella turcica.

Administer mild analgesics for headache as ordered.

Perform frequent oral hygiene with soft swabs to cleanse the teeth and mouth rinses; no toothbrushing.